Unit 1 Flashcards
What do recent studies show about maternal nutrition at conception
At time of conception it influences placental development and function.
Feral genomic imprinting and programming at conception directly tied to maternal peri conception nutrition and child’s long term health.
Preconception
The period before (at least two years) and between consecutive pregnancies
Proximal preconception
Period immediately preceding pregnancy (up to 2 years prior)
Distal preconception
Adolescence or in general a longer time before pregnancy
What is periconception
The preceding and immediately following human conception
Periconcepetion boundary
3 months before pregnancy and up to the first trimester
How long does it take for sperm to be made then released
10 weeks
How long does it take for eggs to be released
14weeks
What is the phases of periconception
Gametogenesis, fertilisation, implantation, embryogenesis, plancentation
What are the 5 ways to help make a healthy baby at periconception
Optimise health
Folic acid
Iodine
Healthy diet and lifestyle
Excess weight
How does obesity affect fertility
It tends to not make people inferior rather subfertile
How does obesity affect womens hormones
Higher levels of estrogen, androgens and leptin than non obese
How does obesity affect men’s hormones
Lower levels testosterone, increased estogen and leptin levels
How does obesity physiologically affect men’s reproduction
Reduced sperm production, erectile dusfunction
How does inadequate body fat affect women’s hormones
Decreases esteogen, LH, FSH
What did the Dutch famine reveal
Long terms affect of nutrient deficiencies were related to timing of insult
Children of pregnant women exposed to famine were more susceptible to
Obesity, diabetes, CVD, protein in urine and other health problems
Could the children of women exposed to famine who were small also make their children small
Yes
What is the barker hypothesis
Fetal under nutrition in middle to late gestation, which leads to disproportionate fetal growth, programs later CHD also lower glucose tolerance
What is vonsidered low birth weight
2.5kg
What is maternal fetal competition
Young mothers are more likely to have LBW babies due to the fetal-maternal competition as they are still growing themselves so they are fighting each other for the nutrients
What 7 micronutrients should mothers be keeping an eye on during periconception
Choline
Iron
Iodine
Zinc
Omega-3 fatty acids and B12
Multivitamins
Folic acid
What effect does iron have on periconception
Iron deficiency anaemia is linked with LBW, delayed development, preteen birth, infections and postpartum haemorrhage
What effect does iodine have on periconception
Neurocognitive
What effect does zinc have on periconception
Preterm birth
Placental function
Why have omega 3 fatty acids and b12 at periconception
Altered lipid metabolism
Why multivitamins at periconception
Neural tube defects, congenital heart defect
Urinary tract defect
Limb reduction defect
Preeclampsia
What have folic acid at periconception
Neural tube defects
Congenital malformations
Preeclampsia
Autism spectrum disorder
Increase sperm count and viability
Why have choline at periconception.
Brain development
When should you take folic acid periconception
800mcg tablet daily 4weeks before and 12weeks after becoming. Pregnant
How is mandatory folate fortification of bread expected to reduce NTD
Reduce annually between 4-14
Why does WHO Recommend having vit A for pregnant women
Prevent night blindness in deficient settings
How are population and fertility rates changing
Fertility rates are decreasing but population increasing
How many stages of pregnancy are there
10
What is the first stage of pregnancy
Conception - sperm fertilises the egg - embryo attaches to uterine wall
What is the second stage of pregnancy
4 weeks - structures that form the neck and face begin to become evident. Organs start (lungs, stomach and liver) or continue (heart, blood vessels) to develop. Home preg test are now positive
What is the first organ to develop in babies
brain
3rd stage of pregnancy
8 weeks - babies now the size of a grape. Face structures are forming. Arms and legs are now formed and fingers and toes more distinct. Embryo now considered a fetus
4th stage of pregnancy
- 12 weeks - fetus starts to make its own movements; Baby has detectable heartbeat and sex organs of baby should start to become clear.
5 th stage of pregnancy
- 16 weeks - baby can now blink and the heart and blood vessels are now fully formed; fingers and toes should have prints
6th stage of pregnancy
- 20weeks - baby can suck thumb, yawn, stretch and make faces. Mother should now feel the baby moving.
7th stage of pregnancy
24 weeks - baby responds to sounds by moving or increasing pulse; inner ear is devloped so may be able to sense being upside down.
8th stage of pregnancy
- 28weeks - baby changes position frequently; theres a good chance of survival if baby was born premature now
9th stage of pregnancy
- 32weeks - layer of fat starts to form underskin making it become less wrinkly; it will gain up to half its birth weight between now and pregnancy
10th stage of pregnancy
- 36weeks - the brain is developing rapidly now; lungs are nearly fully developed; head is usually positioned down into the pelvis now
amniotic sac
- Membrane that forms around the embryo 2 weeks after conception, filled mainly with water
-way to feed the baby with PRO, CHO, lipids, phospholipids, urea and electrolytes.
What does the fluid in the amniotic sac allow the fetus to do
move and protects it from infection, temperature, dehydration and impact.
what are teratogens
Any agent that can disturb the development of an embryo or fetus. May cause a birth defect or halt the pregnancy.
What are the 4 classes of teratogens
radiation, maternal infections, chemicals and drugs.
- Once the kids are further developed they become less sensitive to the teratogens
pre natal period
From conception until birth
postnatal period
from birth till death
What is EDD
estimated date of delivery
1st trimester
conception till 12th week
2nd trimester
13th to 28th weeks
3rd trimester
29th to birth
pre term
<37weeks
post term
> 42weeks
when do ultrasounds normally occur
8 weeks - confirming pregnancy and estimating birth date
12-14 weeks - can screen for down syndrome etc. - based on a risk assessment
18-20 weeks - anatomy scan
pre term birth complications
short term:
respiratory distress syndrome
Heart: patent ductas arteriosus
brain: intraventricular hemorrhage
GI: necrotizing enterocolitis
Long term:
cognitive, vision, hearing, ADHD, anxiety, asthma, SIDS
what does the placenta do?
carries oxygen, nutrients and antibodies from mother to fetus and waste material including CO2 from fetus to mother
how is the placenta connected to the embryo/ fetus
umbilical cord
What hormones does the placenta produce
Human chorionic gonatropin (HCG)
progesterone
relaxin
human placental lactogens
What does HCG hormone do
prevents ovaries from releasing eggs and stimulates the ovaries to produce estrogen and progesterone
What does progeterone released from placenta do
produced by placenta after 12weeks. Is primarily responsible for maintenance of pregnancy.
What does relaxin produced by placenta do
acts with progesterone to maintain pregnancy and relaxation of pelvic ligaments towards end
What does human placental lactogens produced by placenta do
(prolactin and growth hormone) to promote mammory gland (boobs) growth
what are the placenta transport mechanisms
passive diffusion
facilitated diffusion
active transport
solvent drag
how much weight is gained during pregnancies
12-15kg
What causes weight gain during pregnancy
fat disposition, growth of reproductive organs, fetal tissues
what stops the menstural cycle during pregnancy
progesterone and oestrogen - they rise continually throughout pregnancy
what does high levels of oestrogen during pregnancy do
promotes prolactin
what does prolactin during pregnancy do
mediates a change in the structure of mammary glands from ductal to lobular-alveolar = milk hormone
why is parathyroid hormone increased during pregnancy
to enhance calcium uptake in the gut and reabsorption in the kidney
which adrenal hormones increase during pregnancy
cortisol and aldostreone
Where is human placental lactogen (HPL) produced from
placenta
what does HPL DECREASE during pregnancy
maternal insulin sensitivity and maternal glucose utilization - this increases blood glucose levels and ensures ftus gets adequate nutrition
what does HPL increase during pregnancy
gluconeogenesis - to increase maternal blood glucose levels
what is HPL main purpose
to increase maternal blood sugar levels. this helps support fetal nutrition even when there maternal malnutrition
what are the renal changes during pregnancy
renal plasma flow increases
what dies aldosterone do during pregnancy
increases the reabsorption of Na ions and secretion of K in the kidneys
What dies EPO do during pregnancy
its a glycoprotein hormone that control RBC production
what is the cardiovascular change during pregnancy
cardiac output increases from 30-50%
When does the cardiac output changes occur
by week 6 and peaks between 16 and 28
Why does increased cardiac output occur
demands of uteroplacental circulation
how does the cardiac output increase
HR increase from 70-90 bpm
stroke volume increases
why does BP usually drop even though cardiac output has increased
because of expanding space in the uterus and developmant of the placenta and systemic vascular resistance decreases
why does lung function change during pregnancy
partly due to progesterone increases and partly due to enlarging unterus interferes with lung expansion
what are the hematological changes
blood volume increases
plasma vloume increases
If plasma volume increases will haemoglobin be lower or higher
lower - additional anaemia
what are gastrointestinal changes during pregnancy
constpation - due to enlarging reproductive organs
GI motility decreases because of progesterone relaxing smooth muscles
heart burn and belching
HCl production decreases
What should you do diet wise to prevent NVP (morning sickness) from being so bad
eat what appeals
eat slowly and small amounts
frequent small CHO meals
ginger and B6 supplements
pharmacological treatments
is ginger or B6 better at removing NVP symptoms
ginger - but not significantly differnt
what is a safe dose of ginger
1g/day, 3-4x
How much does the BMR increase during pregnancy
450-750kj/d
What causes the BMR to increase during pregnancy
added metabolism of uterus and fetus and incresed work of heart and lungs
How much does the TEE (total enenrgy expenditure) increase suring pregnancy
450-750kj/d
Apart from TEE what is the other factor that increases maternal energy requirements
deposition of maternal and fetal tissue
how much increase of energy is required in the 1st trimester
none
hoe much increase of energy is required in the 2nd trimester
1400kj/d
how much increased energy is required during 3rd trimester
1900kj/d
where is the majority of weight gain from in mothers
the fetus
apart from fetus weight what is the other major contributor of weight gain
maternal fat stores
how should overweight/obese people weight gain during pregnancy differ to nirmal or underweight
they should gain less as they already have some of the fat stores required etc.
when does most of the weight gain occur during pregnancy
2nd and 3rd trimester
how much weight should underweight mothers gain during pregnancy
0.51 kg/week
or just gain as much weight as they can
how much weight should normal weight mothers gain during pregnancy
0.42 kg/week
or 17-25kg overall
how much weight should overweight mothers gain during pregnancy
0.28 kg/week
or 14-23kg overall
how much weight should obese mothers gain during pregnancy
0.22kg/week
or 11-19kg overall
if youre having twins how much extra weight should you gain compared to single baby mothers
depends on prepregnancy weight but around 6-10kg
when does gestational weight gain mostly occur
1/3 in 2nd trimester and
2/3 in 3rd trimester
what are 2 pieces of advice for pregnant women to do with weight gain during pregnancy
height and weight measured at booking
women made aware of weight gain guidelines
how can we prevent excessive gestational weight gain
diet, exercise or both
What is the effect of postpartum weight retention
every pregnancy gain more weight so end up obese. so need to try come back to a healthy weight after each pregnancy
Do we recommend weight loss during pregnancy
no just appropriate weight gain
what % of women are entering pregnancy as overweigth or obese
54%
How is obesity associated with miscarriage and stillbirths
increased risk
How is obesity associated with pregnancy-induced hypertension
HIgh BP after 20wks gestation
How is obesity associated with venous thromboembolism
increased risk - blood clot within vein
How is obesity associated with delivery complications
increased risk - labour induction adn caesarean delivery
How is obesity associated with diabetes
increased risk of gestational diabetes mellitus
what is gestational diabtes
women without previously diagnosed diabetes exhibit high blood glucose levels durong pregnancy
what effect does gestetional diabetes have on the baby
exposes baby to higher glucose levels
this leads to increase fetal levels of insulin
due to the growth stimulating effects of insulin this can lead to excessive growth and macrosomia (fetal overgrowth)
And a higher risk of developing T2D later in life
what effects does gestational diabetes have on the mother
higher risk of getting it in future pregnancies
increased risk of T2D
c section more likely due to baby being bigger
induction if baby to big
How do we detect gestational diabetes
screening recommened/offered by healthcarers
What effects does maternal obesity have on the baby
increased risk of congenital abnormalities, NTD, small for gestational age, large for gestational age, neonatal mortality
What are the key nutrients during pregnancy
LCPUFA
iron
iodine
calcium
vit A
What do LCPUFA do for maternal nutrition?
normal fetal development- particularly neural and visual function
What is a rich supply of n-3 fatty acids during pregnancy associated with
reduced incidence of low birth weight
What effects do large amounts of methylmecury have on the baby
damage the development of nervous system of the fetus and delay mental development
why do we need increased iron during pregnancy
maternal blood cell expands so we have more blood, we have the fetus which needs its own blood, and need to account for blood loss for the mother during pregnancy
what is the RDI ofr pregnant women for iron
27mg/d
What risk does iron deficiency have on the baby
LBW, small for gestational age (SGA) preterm birth, decreased infant iron stores, impaired cognition and growth of child
What risk does iron deficiency have on mother
increase the risk of cardiac failure or death from peripartum hemorrhage
What is the reccommended iron supplementation
60mg/d for pregnant women living in places where malnutrition is prevalent
Is preventative iron supplementation beneficial
further investigation needed regarding risks and benefits
What are some interventions aimed at preventing iron deficiency
food-based stratergies
iron supplementation
fortification of staple foods with iron
delayed or optimal cord clamping
What does delayed cord clamping do
improves iron status of baby
What does iron do during pregnancy
essential for production of thyroid hormones - these regulate metabolism and for normal growth and neurocognitve development of the fetus, infant and child
What does severe iodine deficiency do
causes intellectual disability
What is the recommendation for [reventing iodine deficiency
salt iodisation
do pregnant women have a higher requirement for iodine deficiency
yes - meaning they’re more susceptible to iodine deficiency
What is the recommendation for iodine supplementation for pregnant women
150mcg tablet once a day when pregnant and breastfeeding
Why is calcium important in pregnancy
approx 30g calcium tranferred to fetal skeleton by end of pregnancy
How do mothers get more calcium during pregnancy
increased intestinal absorption,
Vit A requirement
important in reactions involving cell differentiation
where does vit A deficinecy normally occur
rare in industrialised countries but major problem in developing
What can a vit A deficiency do
malformation in fetal lungs, urinary tract and heart
What can excessive intakes of vit A do?
increase risk of fetal abnormalities
What is listeria
risk of listeriosis - food bourne bacteria - doesnt cause problems in helathy individuals but problem in immune compromised
What are listeria symptoms
influenza type symptoms and can result in premature labour and reduced fetal movements
What precautions should you take to prevent lysteria
foods should be heated to 70c+
pregnant women should avoid unsafe foods
2 unsafe foods for lysteria
uncooked, smoked or ready to eat fisj or seafood.
pre prepared or stored salads and coleslaws
What is toxoplasmosis
is a parasitic disease
What can toxoplasmosis do
cause eye or brain damage in unborn babies
Where can toxoplasmosis infection come from
similar to listeria + cats
how does alcohol physiologically affect baby
readily crosses the placenta so baby levels are similar to maternal
What is the main effect of drinking alcohol whilst pregnant
fetal alcohol syndrome
What is fetal alcohol syndrome
growth deficinecy
CNS disfunction
specific pattern of facial charateristics
What are NZ recommendation for mothers to do with alcohol
avoid drinking for entire pregnancy
What are the 2 lactation hormones
prolactin and oxytocin
What does prolactin do for lactation
stimulates milk production via suckling,
what suppresses prolactin
prolactin-inhibitin factor - released during last 3 months of pregnancy to allow body to prepare for milk production
What does oxytocin do for lactation
stimulates ejection of milk from the milk gland into duct via suckiling
What is lactogenesis
milk production
what is the 1st stage of lactogenesis
begins last trimester of pregnancy
1st stage of milk production extends to first few days postpartum
Lactogenesis 2
begins 2-5 days postpartum
increased blood flow to mammary gland
when milk ‘comes in’
change in milk composition
lactogenesis 3
marked by stable milk composition
maintenance stage
When is colostrum produced
mid pregnancy to first few days after birth
What is colostrum milk like
thick, sticky, concentrated milk with a mild laxative effect
what is. the general composition of colostrum
lymphocytes
IgA, IgM - help with immunisation
high protein (low fat)
vitamins and minerals
When should breastfeeding be initiated
within first hour after birth
what are the babies signs to initiate feed
suck and swallow - coordianted pattern
oral search reflex
rooting reflex
how does breastfeeding work
suction created by the babies mouth creates pressure and teat ejects milk
Ways to establish breast feeding
skin to skin contact
staying hydrated
responsive feeding - babies hunger cues
emptying breasts
What is breast milk made up of (10)
water
protein
CHO (lactose)
various fats
antibodies
vitamins and minerals
human milk oligosaccharides
800 strands bacteria
other immune cells
hormones
What % of milk is water
88%
do babies need water
no if they’re breastfed
How does milk composition change in terms of fat
low fat at beginning higher towards end
Protein in milk
relatively low amount
CHO in milk
mostly lactose
what is human milk oligosaccharides
complex, indigestable, medium length CHO with lactose on one end
Whhat do prebiotics do in human milk
stimulate groeth of good bacteria. and inhibits bad bacteria
What are group 1 vitamins and minerals
ones that are affected by maternal status
What are group 2 vitamins
not affected by maternal status
What is the features of iron in human milk
iron concentration is low but highly bioavailable
what dies lactoferrin do
inhibits growth of some tumours and also halps babies absorb iron (founf in teh milk)
What affect does sustained IDA have on babies
irreversable amd detrimental effects on intellectual and motor performance
What are the estimated energy requirements of lactating women
0-6months 2000 kj above non pregnant non lactating women
>6months 1680kj
What are the WHO recommendations to help breast feeding
start within 1st hour
exclusive breastfeeding - only breast milk nohing else
breastfeed baby on demand
no use of bottles, teats or pacifiers
How long is exclusive breast feedong recommended for
first 6 months
How long should babies be breast fed for
up to 2 years or longer
what is partial breast feeding
baby receives some breast milk and some infant formula or other solid food
What are benefits of breast feeding for baby
reductions in infant morbidity and mortality
reductions in chronic disease
increased cognitive function
benefits of breastfeeding for mother
protects mothers health
helps delay new pregnancy
help mother return to prepregnancy weight
definition of baby friendly hospital
a health car facility where the practitioners who care for women and babies adopt practices that aim to protect, promote and support exclusive breastfeeding from birth (while also ensuring those who choose not to are supported)
what is the international code of marketing of breast milk substitutes
restrict the marketing of breast milk substitutes to ensure that mothers are not discouraged from breatfeeding and that substitutes are used safely if needed
